Provider Demographics
NPI:1710326707
Name:VASQUEZ DE BRACAMONTE, DIEGO ALONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:ALONSO
Last Name:VASQUEZ DE BRACAMONTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3100
Mailing Address - Country:US
Mailing Address - Phone:412-621-1818
Mailing Address - Fax:412-621-4337
Practice Address - Street 1:970 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3100
Practice Address - Country:US
Practice Address - Phone:412-621-1818
Practice Address - Fax:412-621-4337
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459795207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103248431Medicaid
14023786OtherCAQH